Get Add/adhd Prior Authorization Request Form (page 1 Of ... - Optumrx

Filling out the ADD/ADHD Prior Authorization Request Form is a crucial step in securing necessary medication for individuals diagnosed with ADHD or ADD. This guide provides clear, step-by-step instructions on how to accurately complete the form, ensuring all required information is submitted for timely processing.

Follow the steps to effectively complete the ADD/ADHD Prior Authorization Request Form

1. Press the ‘Get Form’ button to access the ADD/ADHD Prior Authorization Request Form for completion.
2. In the 'Member Information' section, provide the member's full name, insurance ID number, date of birth, and contact information, including phone number and address.
3. Fill in the 'Provider Information' section with the provider's name, NPI number, and contact details including office phone and fax numbers.
4. In the 'Medication Information' section, specify the medication name, strength, and whether this is a continuation of therapy. Provide directions for use and dosage form.
5. Complete the 'Clinical Information' section by selecting the requested medication and diagnosis from the provided options and answering any related questions, ensuring to document prior medication history as necessary.
6. Provide detailed answers to questions related to previous medication failures or contraindications for specified medications if applicable.
7. If additional comments or relevant information is available, fill in the provided space in the last section of the form.
8. Review all entries to ensure accuracy and completeness before submission.
9. After ensuring all information is correctly filled in, choose to save changes, download, print, or share the filled form as required.

Complete your ADD/ADHD Prior Authorization Request Form online for a smoother and more efficient process.